Interventional Angioplasty, a Growing Therapeutic Approach to the Superior Vena Cava Obstruction in the Presence of Hemodialysis Catheters: A Report of Two Cases

Abstract

Background: The long-term resistance of indwelling hemodialysis catheters leads to the development<br />of the superior vena cava (SVC) syndrome due to the obstruction of the dialysis catheters. The<br />management of these cases needs technically challenging interventional procedures using<br />balloon inflation or stent implantation at the SVC/right atrium junction. Hereby, we report 2<br />cases of the SVC syndrome in the setting of hemodialysis catheters which were successfully<br />treated via interventional angioplasty.<br />Case Presentation: The first case was a 57-year-old man who was referred to us with facial congestion,<br />gradual loss of consciousness, and fever. The patient underwent emergent hemodialysis. The<br />source of the fever was found to be an infected permacath in the left internal jugular vein. He<br />underwent hemodialysis through a right-sided access catheter. Upon the termination of the<br />fever, the jugular access was exited and an arteriovenous fistula (AVF) was implanted in the<br />right arm. After a while, the patient experienced swelling in the right arm. Finally, he<br />underwent angioplasty on the occluded AVF. On follow-up, the arm swelling had faded<br />gradually. The second case was a 60-year-old man who was referred to us with a diagnosis of<br />under-dialysis. On admission, the patient's permacath was removed and an AVF was implanted<br />in his right arm to replace a dysfunctional AVF previously inserted in his left arm. After the<br />maturation of the right arm's AVF, the patient underwent regular hemodialysis sessions without<br />complications. After 1 year, under-dialysis occurred again. On venous angiography, a cut-down<br />venous drainage from the origin of the brachiocephalic vein up to its entry into the right atrium<br />was seen.<br />Conclusions: Interventional angioplasty is a therapeutic approach to the SVC obstruction in the<br />presence of hemodialysis catheters.